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Crabtree E, Uribe K, Smith SM, Roberts D, Salmon JH, Bower JJ, Song L, Bastola P, Hirsch ML, Gilger BC. Inhibition of experimental autoimmune uveitis by intravitreal AAV-Equine-IL10 gene therapy. PLoS One 2022; 17:e0270972. [PMID: 35980983 PMCID: PMC9387812 DOI: 10.1371/journal.pone.0270972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 06/21/2022] [Indexed: 12/04/2022] Open
Abstract
Equine recurrent uveitis (ERU) is a spontaneous, painful, and vision threatening disease affecting up to 25% of equine populations worldwide. Current treatments of ERU are non-specific and have many side effects which limits them to short-term use. In order to develop an effective therapy for ERU, we investigated the use of adeno-associated virus (AAV) gene therapy, exploiting a natural immune tolerance mechanism induced by equine interleukin-10 (Equine-IL10). The purpose of this study was to evaluate the therapeutic efficacy of a single intravitreal (IVT) dose of AAV8-Equine-IL10 gene therapy for inhibition of experimental autoimmune uveitis (EAU) in rats. Each rat was dosed intravitreally (IVT) in both eyes with either balanced salt solution (BSS) (control; n = 4), AAV8-Equine-IL10 at a low dose (2.4x109 vg; n = 5) or high dose (2.4x1010 vg; n = 5). EAU was induced in all groups of rats 7 days after IVT injections and euthanized 21 days post-injection. Ophthalmic examination and aqueous humor (AH) cell counts were recorded with the observer blinded to the treatment groups. Histopathology and qPCR were performed on selected ocular tissues. Data presented herein demonstrate that AAV8-Equine-IL10 treated rats exhibited a significant decrease in clinical inflammatory scores and AH cell counts compared to BSS-treated EAU eyes on days 10, 12 and 14 post EAU induction at both administered vector doses. Mean cellular histologic infiltrative scores were also significantly less in AAV8-Equine-IL10 dosed rats compared to the BSS group. Intravitreal injection of AAV8-Equine-IL10 resulted in Equine-IL10 cDNA expression in the ciliary body, retina, cornea, and optic nerve in a dose-dependent manner. A single IVT injection of AAV8-Equine-IL10 appeared to be well-tolerated and inhibited EAU even at the lowest administered dose. These results demonstrate safety and efficacy of AAV8-Equine-IL10 to prevent EAU and support continued exploration of AAV gene therapy for the treatment of equine and perhaps human recurrent uveitis.
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Affiliation(s)
- Elizabeth Crabtree
- Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Katy Uribe
- Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Sara M. Smith
- Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Darby Roberts
- Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Jacklyn H. Salmon
- Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Jacquelyn J. Bower
- Ophthalmology, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Liujiang Song
- Ophthalmology, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Gene Therapy Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Prabhakar Bastola
- Ophthalmology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Matthew L. Hirsch
- Ophthalmology, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Gene Therapy Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Brian C. Gilger
- Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, United States of America
- Ophthalmology, University of North Carolina, Chapel Hill, North Carolina, United States of America
- * E-mail:
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Bischof A, Papinutto N, Keshavan A, Rajesh A, Kirkish G, Zhang X, Mallott JM, Asteggiano C, Sacco S, Gundel TJ, Zhao C, Stern WA, Caverzasi E, Zhou Y, Gomez R, Ragan NR, Santaniello A, Zhu AH, Juwono J, Bevan CJ, Bove RM, Crabtree E, Gelfand JM, Goodin DS, Graves JS, Green AJ, Oksenberg JR, Waubant E, Wilson MR, Zamvil SS, Cree BA, Hauser SL, Henry RG. Reply to "Spinal cord atrophy is a preclinical marker of progressive MS". Ann Neurol 2022; 91:735-736. [PMID: 35233827 PMCID: PMC9511767 DOI: 10.1002/ana.26340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Antje Bischof
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA.,Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Germany
| | - Nico Papinutto
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Anisha Keshavan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Anand Rajesh
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Gina Kirkish
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Xinheng Zhang
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jacob M Mallott
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Carlo Asteggiano
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Simone Sacco
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Tristan J Gundel
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Chao Zhao
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - William A Stern
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Eduardo Caverzasi
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Yifan Zhou
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Refujia Gomez
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Nicholas R Ragan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Adam Santaniello
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Alyssa H Zhu
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jeremy Juwono
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Carolyn J Bevan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Riley M Bove
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Elizabeth Crabtree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jeffrey M Gelfand
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Douglas S Goodin
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jennifer S Graves
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Ari J Green
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jorge R Oksenberg
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Emmanuelle Waubant
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Michael R Wilson
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Scott S Zamvil
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
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- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Bruce A Cree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Stephen L Hauser
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Roland G Henry
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
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Bischof A, Papinutto N, Keshavan A, Rajesh A, Kirkish G, Zhang X, Mallott JM, Asteggiano C, Sacco S, Gundel TJ, Zhao C, Stern WA, Caverzasi E, Zhou Y, Gomez R, Ragan NR, Santaniello A, Zhu AH, Juwono J, Bevan CJ, Bove RM, Crabtree E, Gelfand JM, Goodin DS, Graves JS, Green AJ, Oksenberg JR, Waubant E, Wilson MR, Zamvil SS, Cree BA, Hauser SL, Henry RG. Spinal cord atrophy predicts progressive disease in relapsing multiple sclerosis. Ann Neurol 2021; 91:268-281. [PMID: 34878197 PMCID: PMC8916838 DOI: 10.1002/ana.26281] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 11/06/2022]
Abstract
Objective A major challenge in multiple sclerosis (MS) research is the understanding of silent progression and Progressive MS. Using a novel method to accurately capture upper cervical cord area from legacy brain MRI scans we aimed to study the role of spinal cord and brain atrophy for silent progression and conversion to secondary progressive disease (SPMS). Methods From a single‐center observational study, all RRMS (n = 360) and SPMS (n = 47) patients and 80 matched controls were evaluated. RRMS patient subsets who converted to SPMS (n = 54) or silently progressed (n = 159), respectively, during the 12‐year observation period were compared to clinically matched RRMS patients remaining RRMS (n = 54) or stable (n = 147), respectively. From brain MRI, we assessed the value of brain and spinal cord measures to predict silent progression and SPMS conversion. Results Patients who developed SPMS showed faster cord atrophy rates (−2.19%/yr) at least 4 years before conversion compared to their RRMS matches (−0.88%/yr, p < 0.001). Spinal cord atrophy rates decelerated after conversion (−1.63%/yr, p = 0.010) towards those of SPMS patients from study entry (−1.04%). Each 1% faster spinal cord atrophy rate was associated with 69% (p < 0.0001) and 53% (p < 0.0001) shorter time to silent progression and SPMS conversion, respectively. Interpretation Silent progression and conversion to secondary progressive disease are predominantly related to cervical cord atrophy. This atrophy is often present from the earliest disease stages and predicts the speed of silent progression and conversion to Progressive MS. Diagnosis of SPMS is rather a late recognition of this neurodegenerative process than a distinct disease phase. ANN NEUROL 2022;91:268–281
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Affiliation(s)
- Antje Bischof
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Nico Papinutto
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Anisha Keshavan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Anand Rajesh
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Gina Kirkish
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Xinheng Zhang
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jacob M Mallott
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Carlo Asteggiano
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Simone Sacco
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Tristan J Gundel
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Chao Zhao
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - William A Stern
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Eduardo Caverzasi
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Yifan Zhou
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Refujia Gomez
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Nicholas R Ragan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Adam Santaniello
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Alyssa H Zhu
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jeremy Juwono
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Carolyn J Bevan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Riley M Bove
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Elizabeth Crabtree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jeffrey M Gelfand
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Douglas S Goodin
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jennifer S Graves
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Ari J Green
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jorge R Oksenberg
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Emmanuelle Waubant
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Michael R Wilson
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Scott S Zamvil
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
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- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Bruce A Cree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Stephen L Hauser
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Roland G Henry
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
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Zhou X, Singh S, Baumann R, Barba P, Landefeld J, Casaccia P, Sand IK, Xia Z, Weiner H, Chitnis T, Chandran S, Connick P, Otaegui D, Castillo-Triviño T, Caillier SJ, Santaniello A, Ackermann G, Humphrey G, Negrotto L, Farez M, Hohlfeld R, Pröbstel AK, Jia X, Graves J, Bar-or A, Oksenberg JR, Gelfand J, Wilson MR, Crabtree E, Zamvil SS, Correale J, Cree BA, Hauser SL, Knight R, Baranzini SE. Household paired design reduces variance and increases power in multi-city gut microbiome study in multiple sclerosis. Mult Scler 2020; 27:1352458520924594. [PMID: 33115343 PMCID: PMC7968892 DOI: 10.1177/1352458520924594] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Evidence for a role of human gut microbiota in multiple sclerosis (MS) risk is mounting, yet large variability is seen across studies. This is, in part, due to the lack of standardization of study protocols, sample collection methods, and sequencing approaches. OBJECTIVE This study aims to address the effect of a household experimental design, sample collection, and sequencing approaches in a gut microbiome study in MS subjects from a multi-city study population. METHODS We analyzed 128 MS patient and cohabiting healthy control pairs from the International MS Microbiome Study (iMSMS). A total of 1005 snap-frozen or desiccated Q-tip stool samples were collected and evaluated using 16S and shallow whole-metagenome shotgun sequencing. RESULTS The intra-individual variance observed by different collection strategies was dramatically lower than inter-individual variance. Shallow shotgun highly correlated with 16S sequencing. Participant house and recruitment site accounted for the two largest sources of microbial variance, while higher microbial similarity was seen in household-matched participants as hypothesized. A significant proportion of the variance in dietary intake was also dominated by geographic distance. CONCLUSION A household pair study largely overcomes common inherent limitations and increases statistical power in population-based microbiome studies.
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Crabtree E, Song L, Llanga T, Bower JJ, Cullen M, Salmon JH, Hirsch ML, Gilger BC. AAV-mediated expression of HLA-G1/5 reduces severity of experimental autoimmune uveitis. Sci Rep 2019; 9:19864. [PMID: 31882729 PMCID: PMC6934797 DOI: 10.1038/s41598-019-56462-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/04/2019] [Indexed: 12/21/2022] Open
Abstract
Non-infectious uveitis (NIU) is an intractable, recurrent, and painful disease that is a common cause of vision loss. Available treatments of NIU, such as the use of topical corticosteroids, are non-specific and have serious side effects which limits them to short-term use; however, NIU requires long-term treatment to prevent vision loss. Therefore, a single dose therapeutic that mediates long-term immunosuppression with minimal side effects is desirable. In order to develop an effective long-term therapy for NIU, an adeno-associated virus (AAV) gene therapy approach was used to exploit a natural immune tolerance mechanism induced by the human leukocyte antigen G (HLA-G). To mimic the prevention of NIU, naïve Lewis rats received a single intravitreal injection of AAV particles harboring codon-optimized cDNAs encoding HLA-G1 and HLA-G5 isoforms one week prior to the induction of experimental autoimmune uveitis (EAU). AAV-mediated expression of the HLA-G-1 and -5 transgenes in the targeted ocular tissues following a single intravitreal injection of AAV-HLA-G1/5 significantly decreased clinical and histopathological inflammation scores compared to untreated EAU eyes (p < 0.04). Thus, localized ocular gene delivery of AAV-HLA-G1/5 may reduce the off-target risks and establish a long-term immunosuppressive effect that would serve as an effective and novel therapeutic strategy for NIU, with the potential for applications to additional ocular immune-mediated diseases.
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Affiliation(s)
- Elizabeth Crabtree
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Liujiang Song
- Department of Pediatrics, Hunan Normal University Medical College, Changsha, Hunan, China
- Ophthalmology, University of North Carolina, Chapel Hill, NC, USA
- Gene Therapy Center, University of North Carolina, Chapel Hill, NC, USA
| | - Telmo Llanga
- Ophthalmology, University of North Carolina, Chapel Hill, NC, USA
- Gene Therapy Center, University of North Carolina, Chapel Hill, NC, USA
| | - Jacquelyn J Bower
- Ophthalmology, University of North Carolina, Chapel Hill, NC, USA
- Gene Therapy Center, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Megan Cullen
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Jacklyn H Salmon
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Matthew L Hirsch
- Ophthalmology, University of North Carolina, Chapel Hill, NC, USA
- Gene Therapy Center, University of North Carolina, Chapel Hill, NC, USA
| | - Brian C Gilger
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.
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Holmes RS, Crabtree E, McDonagh MS. Comparative effectiveness and harms of long-acting insulins for type 1 and type 2 diabetes: A systematic review and meta-analysis. Diabetes Obes Metab 2019; 21:984-992. [PMID: 30552792 DOI: 10.1111/dom.13614] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/30/2018] [Accepted: 12/13/2018] [Indexed: 12/20/2022]
Abstract
AIM To review evidence comparing benefits and harms of long-acting insulins in patients with type 1 and 2 diabetes. METHODS MEDLINE and two Cochrane databases were searched during February 2018. Two authors selected studies meeting inclusion criteria and assessed their quality. Comparative studies of adult or paediatric patients with diabetes treated with insulin degludec, detemir or glargine were included. Meta-analysis was used to combine results of similar studies, and the I2 statistic calculated to assess statistical heterogeneity. RESULTS Of 2534 citations reviewed, 70 studies met the inclusion criteria. No statistically significant differences in HbA1c were seen between any two insulins or formulations. Hypoglycaemia was less probable with degludec than with glargine, including nocturnal hypoglycaemia in type 1 (rate ratio 0.68, 95% CI 0.56-0.81) and type 2 diabetes (rate ratio 0.73, 95% CI 0.65-0.82), and severe hypoglycaemia in type 2 diabetes (relative risk 0.72, 95% CI 0.54-0.96). Patients with type 2 diabetes had higher rates of withdrawal because of adverse events when treated with detemir compared with glargine (relative risk 2.1, 95% CI 1.4-3.3). Adults taking detemir gained about 1 kg less body weight than those taking degludec (type 1) or glargine (type 2). CONCLUSIONS No differences in glycaemic control were seen between insulin degludec, detemir and glargine. Hypoglycaemia was less probable with degludec than glargine, and patients taking detemir gained less body weight than those given degludec or glargine. In type 2 diabetes, withdrawals as a result of adverse events were more probable with detemir than glargine.
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Affiliation(s)
- Rebecca S Holmes
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Elizabeth Crabtree
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Marian S McDonagh
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
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7
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Bove R, Bevan C, Crabtree E, Zhao C, Gomez R, Garcha P, Morrissey J, Dierkhising J, Green AJ, Hauser SL, Cree BAC, Wallin MT, Gelfand JM. Toward a low-cost, in-home, telemedicine-enabled assessment of disability in multiple sclerosis. Mult Scler 2018; 25:1526-1534. [DOI: 10.1177/1352458518793527] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Remote assessment of neurological disability in people with multiple sclerosis (MS) could improve access to clinical care and efficiency of clinical research. Objective: To develop and validate a telemedicine-based MS disability examination that does not require an in-home examiner. Methods: Adults with MS were recruited after a standardized in-person Expanded Disability Status Scale (EDSS) evaluation, and within 1 week underwent a blinded televideo-enabled EDSS examination with a different clinician. EDSS and tele-EDSS scores were compared. Results: Overall, 41 adults participated (mean (standard deviation (SD)) age: 47.0 years (11.6); median EDSS: 2 (range: 0–7)); 37 required no in-home assistance for the tele-EDSS evaluation (e.g. help positioning camera). Mean difference between EDSS and tele-EDSS was 0.34 (95% confidence interval (CI): 0.07–0.61). For 88% of evaluations, tele-EDSS and EDSS scores were within 1 point (similar to reported in-person inter-rater differences). Unweighted kappa for agreement within 0.5 point was 0.72. Correlation for individual functional systems (FS) ranged from modest (vision: 0.37) to high (bowel/bladder: 0.79). Overall correlation between EDSS and tele-EDSS was 0.89 ( p < 0.0001); and 0.98 ( p < 0.0001) at EDSS range: 4–7. Conclusion: In this proof of principle study, disability evaluation in mild to moderate MS is feasible using telemedicine without an aide at the patient’s location.
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Affiliation(s)
- Riley Bove
- UCSF MS and Neuroinflammation Center, Weill Institute for Neurosciences, Department of Neurology, Division of Neuroinflammation and Glial Biology, University of California, San Francisco, CA, USA
| | - Carolyn Bevan
- UCSF MS and Neuroinflammation Center, Weill Institute for Neurosciences, Department of Neurology, Division of Neuroinflammation and Glial Biology, University of California, San Francisco, CA, USA
| | - Elizabeth Crabtree
- UCSF MS and Neuroinflammation Center, Weill Institute for Neurosciences, Department of Neurology, Division of Neuroinflammation and Glial Biology, University of California, San Francisco, CA, USA
| | - Chao Zhao
- UCSF MS and Neuroinflammation Center, Weill Institute for Neurosciences, Department of Neurology, Division of Neuroinflammation and Glial Biology, University of California, San Francisco, CA, USA
| | - Refujia Gomez
- UCSF MS and Neuroinflammation Center, Weill Institute for Neurosciences, Department of Neurology, Division of Neuroinflammation and Glial Biology, University of California, San Francisco, CA, USA
| | - Priya Garcha
- UCSF MS and Neuroinflammation Center, Weill Institute for Neurosciences, Department of Neurology, Division of Neuroinflammation and Glial Biology, University of California, San Francisco, CA, USA
| | - John Morrissey
- UCSF MS and Neuroinflammation Center, Weill Institute for Neurosciences, Department of Neurology, Division of Neuroinflammation and Glial Biology, University of California, San Francisco, CA, USA
| | - Jason Dierkhising
- UCSF MS and Neuroinflammation Center, Weill Institute for Neurosciences, Department of Neurology, Division of Neuroinflammation and Glial Biology, University of California, San Francisco, CA, USA
| | - Ari J Green
- UCSF MS and Neuroinflammation Center, Weill Institute for Neurosciences, Department of Neurology, Division of Neuroinflammation and Glial Biology, University of California, San Francisco, CA, USA
| | - Stephen L Hauser
- UCSF MS and Neuroinflammation Center, Weill Institute for Neurosciences, Department of Neurology, Division of Neuroinflammation and Glial Biology, University of California, San Francisco, CA, USA
| | - Bruce AC Cree
- UCSF MS and Neuroinflammation Center, Weill Institute for Neurosciences, Department of Neurology, Division of Neuroinflammation and Glial Biology, University of California, San Francisco, CA, USA
| | - Mitchell T Wallin
- VA MS Center of Excellence East, Washington, DC, USA
- Department of Neurology, Georgetown University School of Medicine, Washington, DC, USA
| | - Jeffrey M Gelfand
- UCSF MS and Neuroinflammation Center, Weill Institute for Neurosciences, Department of Neurology, Division of Neuroinflammation and Glial Biology, University of California, San Francisco, CA, USA
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Crabtree E, Brennan E, Davis A, Coyle A. Improving Patient Care Through Nursing Engagement in Evidence-Based Practice. Worldviews Evid Based Nurs 2016; 13:172-5. [DOI: 10.1111/wvn.12126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Elizabeth Crabtree
- Director of Evidence-Based Practice, Quality, Management, and Assistant Professor, Library & Informatics; Medical University of South Carolina; Charleston SC
| | - Emily Brennan
- Informationist, Research Librarian, and Assistant Professor, Library & Informatics; Medical University of South Carolina; Charleston SC
| | - Amanda Davis
- Clinical Evidence-Based Practice Analyst; Medical University of South Carolina; Charleston SC
| | - Andrea Coyle
- Professional Excellence Coordinator, Clinical, Services Administration; Medical University of South Carolina; Charleston SC
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Scheurer D, Crabtree E, Cawley PJ, Lee TH. The Value Equation: Enhancing Patient Outcomes While Constraining Costs. Am J Med Sci 2016; 351:44-51. [DOI: 10.1016/j.amjms.2015.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/08/2015] [Indexed: 10/22/2022]
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Wilson L, Loucks A, Bui C, Gipson G, Zhong L, Schwartzburg A, Crabtree E, Goodin D, Waubant E, McCulloch C. Patient centered decision making: use of conjoint analysis to determine risk-benefit trade-offs for preference sensitive treatment choices. J Neurol Sci 2014; 344:80-7. [PMID: 25037284 DOI: 10.1016/j.jns.2014.06.030] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/28/2014] [Accepted: 06/15/2014] [Indexed: 11/27/2022]
Abstract
UNLABELLED Understanding patient preferences facilitates shared decision-making and focuses on patient-centered outcomes. Little is known about relapsing-remitting multiple sclerosis (RRMS) patient preferences for disease modifying therapies (DMTs). We use choice based conjoint (CBC) analysis to calculate patient preferences for risk/benefit trade-offs for hypothetical DMTs. METHODS Patients with RRMS were surveyed between 2012 and 2013. Our CBC survey mimicked the decision-making process and trade-offs of patients choosing DMTs, based on all possible DMT attributes. Mixed-effects logistic regression analyzed preferences. We estimated maximum acceptable risk trade-offs for various DMT benefits. RESULTS Severe side-effect risks had the biggest impact on patient preference with a 1% risk, decreasing patient preference five-fold compared to no risk. (OR=0.22, p<0.001). Symptom improvement was the most preferred benefit (OR=3.68, p<0.001), followed by prevention of progression of 10 years (OR=2.4, p<0.001). Daily oral administration had the third highest DMT preference rating (OR=2.08, p<0.001). Patients were willing to accept 0.08% severe risk for a year delayed relapse, and 0.22% for 4 vs 2 year prevented progression. CONCLUSION We provided patient preferences and risk-benefit trade-offs for attributes of all available DMTs. Evaluation of patient preferences is a key step in shared decision making and may significantly impact early drug initiation and compliance.
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Affiliation(s)
- Leslie Wilson
- Health Policy and Economics, University of California San Francisco, Departments of Medicine and Pharmacy, 3333 California Street, San Francisco, CA 94143, USA.
| | - Aimee Loucks
- University of California San Francisco, Department of Clinical Pharmacy, 3333 California Street, San Francisco, CA 94143, USA.
| | - Christine Bui
- University of California San Francisco, Department of Clinical Pharmacy, 3333 California Street, San Francisco, CA 94143, USA
| | - Greg Gipson
- University of California San Francisco, Department of Clinical Pharmacy, 3333 California Street, San Francisco, CA 94143, USA
| | - Lixian Zhong
- University of California San Francisco, Department of Clinical Pharmacy, 3333 California Street, San Francisco, CA 94143, USA
| | - Amy Schwartzburg
- University of California San Francisco, Department of Neurology, 1500 Owens Street, Suite 320, San Francisco, CA 94158, USA.
| | - Elizabeth Crabtree
- UCSF Multiple Sclerosis Center, 1500 Owens Street, Suite 320, San Francisco, CA 94158, USA.
| | - Douglas Goodin
- UCSF Multiple Sclerosis Center, 1500 Owens Street, Suite 320, San Francisco, CA 94158, USA.
| | - Emmanuelle Waubant
- University of California San Francisco, Regional Pediatric MS Center Director, 1500 Owens Street, Suite 320, San Francisco, CA 94158, USA.
| | - Charles McCulloch
- Division of Biostatistics, University of California San Francisco, Department of Epidemiology and Biostatistics, 185 Berry Street, Suite 5700, Box 0560, San Francisco, CA 94107-1762, USA.
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11
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Douglas G, Axelrad ME, Brandt ML, Crabtree E, Dietrich JE, French S, Gunn S, Karaviti L, Lopez ME, Macias CG, McCullough LB, Suresh D, Austin E, Reid Sutton V. Guidelines for evaluating and managing children born with disorders of sexual development. Pediatr Ann 2012; 41:e1-7. [PMID: 22494213 DOI: 10.3928/00904481-20120307-09] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Children born with disorders of sexual differentiation (DSD) pose numerous challenges for the parents, family, and treating physicians. The pediatrician is usually the first medical contact for newborns with DSD or for toddlers and children who present with DSD at a later time. Several years ago, we formed a Gender Medicine Team (GMT) at Baylor College of Medicine and Texas Children's Hospital (TCH) to explore and evaluate the most appropriate management strategies, which had long been a matter of concern and contention. Subsequently, the GMT, composed of experts in the fields of endocrinology, ethics, genetics, gynecology, psychology, pediatric surgery, and urology, formed a Task Force to evaluate the information available from our own experiences and from reviews of the literature. Utilizing the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system to assess the evidence and recommendations, the Task Force developed a consensus statement for clinical management of DSD and for making appropriate sex assignments.
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Affiliation(s)
- Ganka Douglas
- Baylor College of Medicine Texas Children’s Hospital, Houston, TX 77030, USA
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Todd S, Bromley J, Ioannou K, Harrison J, Mellor C, Taylor E, Crabtree E. Using Group-Based Parent Training Interventions with Parents of Children with Disabilities: A Description of Process, Content and Outcomes in Clinical Practice. Child Adolesc Ment Health 2010; 15:171-175. [PMID: 32847232 DOI: 10.1111/j.1475-3588.2009.00553.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a need for further development and evaluation of group-based parent- training interventions for parents of children with disabilities. This paper describes interventions delivered in two areas of Greater Manchester. METHOD The process and content of an approach designed for parents of children with learning disabilities and autistic spectrum disorders is described. RESULTS Clinical outcome data for 22 parents/carers are presented. Client feedback about the course is also reported. CONCLUSIONS The data suggest that this intervention is effective in reducing the frequency and impact of children's challenging behaviours, and improving parental psychological well-being. More rigorous and extensive evaluation is required.
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Affiliation(s)
- Samantha Todd
- The Winnicott Centre, Hathersage Road, Manchester, M13 0JE, UK. E-mail:
| | - Jo Bromley
- Carol Kendrick Centre, Baguley, Manchester M23 9XD, UK
| | - Korina Ioannou
- Zochonis Building, University of Manchester, Manchester M13 9PL, UK
| | - James Harrison
- Child and Adolescent Mental Health Services, Royal Bolton Hospital, Bolton BL4 0JR, UK
| | - Christine Mellor
- The Winnicott Centre, Hathersage Road, Manchester, M13 0JE, UK. E-mail:
| | | | - Elizabeth Crabtree
- Learning Disability Team, Alder Hey Children's NHS Foundation Trust, Mulberry House, Alder Road, Liverpool L12 2A, UK
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Best D, Chairatana P, Glawar AF, Crabtree E, Butters TD, Wilson FX, Yu CY, Wang WB, Jia YM, Adachi I, Kato A, Fleet GW. Synthesis of 2-acetamido-1,2-dideoxy-d-galacto-nojirimycin [DGJNAc] from d-glucuronolactone: the first sub-micromolar inhibitor of α-N-acetylgalactosaminidases. Tetrahedron Lett 2010. [DOI: 10.1016/j.tetlet.2010.02.063] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Douglas G, Axelrad M, Brandt M, Crabtree E, Dietrich J, French S, Gunn S, Karaviti L, Lopez, Macias C, McCullough L, Suresh D, Sutton VR. Consensus in Guidelines for Evaluation of DSD by the Texas Children's Hospital Multidisciplinary Gender Medicine Team. Int J Pediatr Endocrinol 2010. [DOI: 10.1186/1687-9856-2010-919707] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Crabtree E. Can the midwife manager meet everyone's needs? Midwives Chron 1985; 99:xiv-xvi. [PMID: 3855161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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